Rating the severity of angioedema symptoms via a novel photo aid may be useful in helping physicians diagnose patients with non-mast cell mediator-induced angioedema (NM-AE), which is distinct from hereditary angioedema, according to a study published in the World Allergy Organizational Journal. 

Angioedema is the spontaneous, often painful, swelling of the subcutaneous skin layer and mucosa of internal organs. Depending on severity, patients may either experience mild symptoms or need emergency care. 

A hallmark of severe angioedema is substantial cutaneous and submucosal swelling, which can be fatal. The authors of the study sought to assess the possibility of using various clinical features and disease aspects of angioedema to classify patients into various angioedema subtypes. 

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The research team conducted a single-center, prospective cohort study between August 2020 and December 2021. Patients with angioedema recruited for this project gave their permission for their photos to be used. All patients had a history of recurrent adverse events of angioedema. They were required to take part in detailed history-taking and to provide medical notes for further evaluation.

Read more about hereditary angioedema etiology 

The authors painstakingly examined every photo taken by the patient and selected pictures that appeared to show signs of swelling. The participants were then asked to rate the worst swelling episode ever encountered and compare it with the swelling in the photo. 

The research team then selected the photos deemed most likely to be mast cell mediator-induced angioedema or non-mast cell mediator-induced angioedema. They then used a flow chart to determine the most likely diagnosis of each patient. This flow chart excluded patients lost to follow-up, and patients who had food allergies, contact dermatitis, and other common allergy causes. The authors also assessed clinical features such as lesions on the hands, feet, face, and genitalia to narrow down their diagnosis. Of 35 patients, 10 were found to have mast cell mediator-induced angioedema, and 25 had non-mast cell mediator-induced angioedema. 

“Patient-rated angioedema severity using a novel photo aid combined with hands angioedema had a high probability of diagnosing NM-AE,” the authors concluded.


Wongsa C, Phinyo P, Dharakul T, Sompornrattanaphan M, Srisuwatchari W, Thongngarm T. Patient-rated angioedema severity using a novel photo-aid for predicting non-mast cell mediator-induced angioedema diagnosisWorld Allergy Organ J. Published online June 27, 2023. doi:10.1016/j.waojou.2023.100784